A Case of Grave's Thyrotoxicosis-Induced Takotsubo Cardiomyopathy Presenting with Cardiac Arrest After Winning the Lottery.

Takotsubo syndrome (TTS) is a nonischemic cardiomyopathy with transient apical ballooning of the left ventricle and reduced ejection fraction that can be caused by severe emotional or physical stress, with diverse clinical presentations. This case describes a patient who went into cardiac arrest at a casino after winning the lottery. She was found to have Takotsubo cardiomyopathy, in the setting of uncontrolled hyperthyroidism. This is a very unique case of TTS presenting with cardiac arrest, and is also an uncommon example of TTS triggered by a positive rather than negative emotional life event.

A Case of Granulomatosis with Polyangiitis Masquerading as Community Acquired Pneumonia.

Granulomatosis with polyangiitis (GPA) has a multitude of presentations, including appearing as a refractory community-acquired pneumonia (CAP) or an isolated localized pulmonary disease. This case describes a patient suspected to have a CAP before further workup and lung biopsy revealed his diagnosis of GPA. This case report demonstrates GPA's diverse presentations, critical complications such as diffuse alveolar hemorrhage (DAH) and cardiac tamponade, and nuanced management options.

Ileocecal Mesentery Arteriovenous Malformation as a Rare Cause of Ectopic Variceal Bleeding in a 58-Year-Old Male With Cirrhosis.

Ectopic varices can be defined as dilated portosystemic venous collaterals that are located at a site other than the esophagus or stomach. These varices can be seen in patients with underlying portal hypertension, but bleeding from them is quite rare. The bleeding usually occurs in patients with a history of intra-abdominal surgery and adhesions. These varices are commonly found in the duodenum or rectum, but they can be present anywhere along the gastrointestinal tract. Currently, there are no well-established guidelines regarding the diagnosis and management of these variceal bleeds, and further investigations with randomized controlled or large-scale trials are required. Here, we report an unusual case of ectopic variceal bleeding from an ileal arteriovenous malformation (AVM), which presented as syncope associated with an acute abdomen in a patient with no prior history of intra-abdominal surgery.

And Yet.

Description As healthcare workers, invested in the wellbeing of our patients while also hoping to grow as individuals, we sometimes tend to view our jobs as a rigid duality-we are either "in love" with our practice and persevere flawlessly through all hardship, or we are "burnt out," coldhearted, and defeated by the heavy workload and expectations of medicine. In reality, we all sit somewhere in the middle of a blurry spectrum, balancing out physical, mental, and emotional pain with the immense honor of saving and cherishing human life, while simultaneously struggling to reconcile our altruistic goals with realistic but necessary human incentives. I want this open-ended work to acknowledge these challenging but critical "and yet" moments, and I hope anyone who is reading it can connect to the words personally and find new insight, regardless of where they are in life.

A Rare Case of Candida glabrata Cervical Spondylodiscitis.

Introduction: Invasive candidiasis can lead to numerous life-threatening sequelae. Candida glabrata is the second-most common causative species of invasive candidiasis. This species possesses a high risk for persistent infection and candidemia. An uncommon complication of invasive candidiasis is spondylodiscitis and can rarely affect the cervical spine. Case Presentation: The patient is a female in her late 50s with a complex medical history inclusive of chronic obstructive pulmonary disease, chronic pain, multiple abdominal surgeries, prolonged intensive care unit admission, and administration of total parenteral nutrition and broad-spectrum antibiotics who presented with complaints of worsening neck pain. She was last hospitalized 3 months prior and found to have C glabrata fungemia but was nonadherent to antifungal therapy.She was found to have advanced C5-6 spondylodiscitis and an epidural abscess. Her surgical cultures grew C glabrata. Despite surgical intervention and antimicrobial therapy, she clinically deteriorated and acquired septic shock with multiorgan failure. Conclusion: This is a rare case of cervical spondylodiscitis caused by a deep-seated C glabrata infection.

Suspected Anaphylactic Reaction Following Second Dose of the Pfizer-BioNTech (BNT162b2) Coronavirus Vaccine in a Geriatric Female.

Description Anaphylaxis is a rare but serious adverse reaction that can occur following mRNA-based vaccination against coronavirus (COVID-19). This is a case of a geriatric patient presenting with hypotension and an urticarial rash with bullous lesions following a syncopal episode with incontinence. She received the second dose of the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine three days prior, and first developed the skin abnormalities the morning after receiving the vaccine. She had no past history of anaphylaxis or allergies to vaccinations. Her presentation met the diagnostic criteria for anaphylaxis, according to the World Allergy Organization: she had acute onset illness involving the skin and was hypotensive with symptoms suggestive of end-organ dysfunction. The latest literature published on anaphylaxis to mRNA-based COVID-19 vaccination indicates that this is an extremely rare complication. From December 14, 2020, to January 18, 2021, 9 943 247 doses of the Pfizer-BioNTech vaccine and 7 581 429 doses of the Moderna vaccine were administered in the United States. Sixty-six of these patients met anaphylaxis criteria. Of these cases, 47 received the Pfizer vaccine and 19 received the Moderna vaccine. Unfortunately, the mechanisms of these adverse reactions remain poorly understood, although it is postulated that particular vaccine components such as polyethylene glycol or polysorbate 80 may be the underlying triggers. This case demonstrates the importance of recognizing anaphylactic signs and symptoms, as well as proper patient education about the benefits and potential, albeit rare, adverse effects, of vaccination.

Elucidation of Novel Molecular Targets for Therapeutic Strategies in Urothelial Carcinoma: A Literature Review.

Urothelial carcinoma therapy is a rapidly evolving and expanding field. Traditional cytotoxic chemotherapy regimens have not produced optimal long-term outcomes, and many urothelial cancer patients have comorbidities that disqualify them as chemotherapy candidates. In recent years, a plethora of novel therapeutic agents that target diverse molecular pathways has emerged as alternative treatment modalities for not only metastatic urothelial carcinoma, but also for muscle-invasive bladder cancer and non-muscle invasive bladder cancer in adjuvant and definitive settings. This review paper aims to discuss the various categories of therapeutic agents for these different types of urothelial cancer, discussing immunotherapy, antibody-drug conjugates, kinase inhibitors, CAR-T cell therapy, peptide vaccination, and other drugs targeting pathways such as angiogenesis, DNA synthesis, mTOR/PI3K/AKT, and EGFR/HER-2.

Standard-Dose Rituximab as Effective Therapy for Treating Malignancy-Related Hemophagocytic Lymphohistiocytosis in the Eldery: A Case Report.

Hemophagocytic lymphohistiocytosis (HLH) is a syndrome involving uncontrolled inflammation due to widespread activation of immune response. HLH can be inherited or acquired secondary to infection, autoimmune, or oncologic processes such as small lymphocytic lymphoma (SLL) or chronic lymphocytic leukemia (CLL). There has been minimal documentation of HLH secondary to SLL/CLL, and results of treatment have been largely unsuccessful. This case describes a critically ill elderly patient with HLH caused by SLL/CLL who was successfully treated with standard-dose rituximab and regained a high quality of life.

Non-neoplastic inflammatory pseudotumor of the lung after immunotherapy for melanoma: A diagnostic pitfall on fine needle aspiration biopsy of lung.

Nivolumab is commonly used as monotherapy or in combination therapy for management of locally advanced or metastatic melanoma; however, it is also associated with immunotherapy-related adverse events concerning for disease progression or tumor flare reaction. This report presents a case of a non-neoplastic pseudotumor of the lung initially mistaken for malignancy that occurred in a patient receiving adjuvant nivolumab therapy following complete resection of stage IIIB melanoma. The diagnosis was made by lung biopsy and confirmed by a wedge resection, with findings consistent with organizing pneumonia type of pulmonary inflammatory pseudotumor rather than malignancy.

A unique case of hemolytic-uremic syndrome secondary to enteropathogenic E Coli.

Causative factors of HUS due to infection are not limited to classic EHEC and Shigella infection. Understanding the effects of EPEC-related HUS and its complications is imperative for early diagnosis and treatment to mitigate long-term sequelae.

An Advanced AIDS Patient With CD4 <20 and Plasmablastic Lymphoma Achieving Complete Response With the V-EPOCH Regimen.

Plasmablastic lymphoma (PBL) is a rare form of non-Hodgkin lymphoma that is highly aggressive and carries a poor prognosis. Although the standard chemotherapy choice for most diffuse large B-cell lymphomas (DLBCL) is R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone), subtypes of DLBCL such as PBL are less responsive to this treatment regimen. The preferred regimens for PBL include infusional EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin hydrochloride), HyperCVAD (cyclophosphamide, vincristine sulfate, doxorubicin hydrochloride, and dexamethasone), or CODOX-M/IVAC (cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate/ifosfamide, etoposide, and high-dose cytarabine). Recent studies have begun to investigate the addition of other agents to these regimens to improve survival. This case report is about a patient with a history of advanced acquired immunodeficiency syndrome (AIDS) with a cluster of differentiation 4 (CD4) count <20 who had CD20 negative plasmablastic lymphoma and was successfully treated with the combination of bortezomib and dose-adjusted EPOCH (V-EPOCH) and intrathecal chemotherapy, achieving complete response with optimal tolerance. To our knowledge, this is the first case to demonstrate a complete response with V-EPOCH for PBL in advanced AIDS with CD4 <20. We aim to highlight the importance of standardizing effective chemotherapeutic approaches to this cancer entity and augment the effectiveness of V-EPOCH therapy in the literature review.